<form id="add-form" class="form-horizontal" role="form" data-toggle="validator" method="POST" action="">

  <!--   <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Registr_activity_id')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-registr_activity_id" data-rule="required" data-source="registr/activity/index" class="form-control selectpage" name="row[registr_activity_id]" type="text" value="">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('User_id')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-user_id" data-rule="required" data-source="user/user/index" data-field="nickname" class="form-control selectpage" name="row[user_id]" type="text" value="">
        </div>
    </div> -->
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Name')}:</label>
        <div class="col-xs-12 col-sm-8">
          
            <input id="c-name" class="form-control" name="row[name]" type="text" value="">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('性別')}:</label>
        <div class="col-xs-12 col-sm-8">
                        
            <select  id="c-sex" class="form-control selectpicker" name="row[gender]">
                {foreach name="sexList" item="vo"}
                    <option value="{$key}" >{$vo}</option>
                {/foreach}
            </select>

        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Id_card')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-id_card" class="form-control" name="row[id_card]" type="text">
        </div>
    </div>
      <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('回鄉證號碼')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-id_card" class="form-control" name="row[return_permit]" type="text">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('出生年份')}:</label>
        <div class="col-xs-12 col-sm-8">
        
                 <input id="c-birthday" class="form-control datetimepicker" data-date-format="YYYY" data-use-current="true" name="row[birthday]" type="text"  value="1990">
        </div>
    </div>
    
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('香港電話')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-mobile" class="form-control" name="row[hk_mobile]" type="text" value="">
        </div>
    </div>
       <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('香港地址')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-mobile" class="form-control" name="row[hk_address]" type="text" value="">
        </div>
    </div>
       <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('內地電話')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-mobile" class="form-control" name="row[nd_mobile]" type="text" value="">
        </div>
    </div>
      
        <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('內地地址')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-mobile" class="form-control" name="row[nd_address]" type="text" value="">
        </div>
    </div>
        <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('電子郵箱')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-mobile" class="form-control" name="row[email]" type="text" value="">
        </div>
    </div>
         <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('家屬電話')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-mobile" class="form-control" name="row[fm_mobile]" type="text" value="">
        </div>
    </div>
         <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('籍貫')}:</label>
        <div class="col-xs-12 col-sm-8">
            <div class="form-inline" data-toggle="cxselect" data-selects="province,city,area">
                    <select  class="province form-control" name="row[province]" data-url="region/area">
                    </select>
                    <select   class="city form-control" name="row[city]" data-url="region/area">
                    </select>
                    <select   class="area form-control" name="row[district]" data-url="region/area">
                    </select>
                </div>
        </div>
    </div>
     <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('學歷')}:</label>
        <div class="col-xs-12 col-sm-8">
          
            <select  id="c-sex" class="form-control selectpicker" name="row[education]">
                {foreach name="eduList" item="vo"}
                    <option value="{$key}">{$vo}</option>
                {/foreach}
            </select>
        </div>
    </div>
     <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('認知途徑')}:</label>
        <div class="col-xs-12 col-sm-8">
         
             <select  id="c-sex" class="form-control selectpicker" name="row[cognitive_approach]">
                {foreach name="cognitiveList" item="vo"}
                    <option value="{$key}">{$vo}</option>
                {/foreach}
            </select>
        </div>
    </div>
     <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('是否選民')}:</label>
        <div class="col-xs-12 col-sm-8">
            
              <select  id="c-sex" class="form-control selectpicker" name="row[is_voter]">

                {foreach name="voterList" item="vo"}
                    <option value="{$key}" >{$vo}</option>
                {/foreach}
            </select>
        </div>
    </div>
     <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('所屬工會')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-mobile" class="form-control" name="row[trade_union]" type="text" value="">
        </div>
    </div>
     <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('咨詢類別')}:</label>
        <div class="col-xs-12 col-sm-8">
             <select  id="c-sex" class="form-control selectpicker" name="row[consultation_type]">

                {foreach name="contentList" item="vo"}
                    <option value="{$vo.id}" >{$vo.name}</option>
                {/foreach}
            </select>
        </div>
    </div>
     <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('諮詢内容')}:</label>
        <div class="col-xs-12 col-sm-8">
            <textarea  class="form-control" rows="5" name="row[consultation_content]" cols="50"></textarea>
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('備註')}:</label>
        <div class="col-xs-12 col-sm-8">
            <textarea  class="form-control" rows="5" name="row[remark]" cols="50"></textarea>
        </div>
    </div>
    <div class="form-group layer-footer">
        <label class="control-label col-xs-12 col-sm-2"></label>
        <div class="col-xs-12 col-sm-8">
            <button type="submit" class="btn btn-success btn-embossed disabled">{:__('OK')}</button>
            <button type="reset" class="btn btn-default btn-embossed">{:__('Reset')}</button>
        </div>
    </div>
</form>
